Background: Absence of suitable implant locations for donor renal vessels may be a major problem in patients with significant central and peripheral vascular disease. We describe a series of 10 patients transplanted successfully utilizing alternative vascular inflow including prosthetic interposition conduits and donor arterial grafts arising from proximal aortic branches.

Methods: This retrospective case study includes patients (n=10) transplanted between 2008-2017 whose iliac arteries were not suitable for implantation of the renal allograft artery, and were turned down for technical concerns in at least one transplant center. All patients underwent CT-angiography for operative planning. Most patients received a prosthetic conduit (aortobiiliac or aortobifemoral) at the time of (n=5) or prior to transplant (n=2). One patient underwent patch angioplasty and iliac artery stenting at transplant. Two patients were transplanted with donor arterial conduits arising from the common hepatic artery (n=1) and the superior mesenteric artery (n=1). Both living (n=6) and deceased donor (n=4) allografts were included. The donor renal vein was anastomosed to either the iliac vein (n=9) or vena cava (n=1). Standard ureteroneocystostomy was performed. Median follow-up was 28 months (range 4 – 68 months).

Results: All recipients had immediate renal allograft function post-transplant. Those recipients ≥1 year post-transplant (n=9) demonstrated normal renal function with creatinine range of 0.9-1.5 mg/dL. Two patients died with functioning renal allograft at 40 and 68 months post-transplant. All remaining patients have stable allograft function at last follow-up. One recipient experienced small bowel necrosis requiring resection following use of the superior mesenteric artery conduit; this patient resumed normal diet with stable allograft function (creatinine 0.6 mg/dL). One recipient required postoperative day 0 thrombectomy of the aortobifemoral graft secondary to distal thrombus; this patient has preserved allograft (creatinine 1.3 mg/dL) and lower extremity function.

Conclusions: Alternative vascular inflow strategies offer equivalent recipient and graft survival for both living- and deceased-donor renal transplants in highly selected patients. These inflow conduits may provide transplant options for patients previously declined due to technical considerations.

CITATION INFORMATION: Mao S., Giorgakis E., Moss A., Taner T. Novel Vascular Inflow Offers Renal Transplantation to Recipients with Severe Central and Peripheral Vascular Disease Am J Transplant. 2017;17 (suppl 3).

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